Restorative materials in pediatric dentistry class

RESTORATIVE
MATERIALS IN
PEDIATRIC DENTISTRY
DR DHANYA K B

Restorative materials are of great importance as they help
rebuild the lost tooth structure and helps maintain the better
oral health.
There has been a quest for newer materials from amalgam to
bonding materials for better adhesion and longevity purpose.
The principal advantage of these new materials is that they
require less retention form, and this is particularly important in
primary teeth to conserve the relatively thin enamel that could
help prevent subsequent caries invasion of dentin
INTRODUCTION

IMPORTANT LIST OF MATERIALS ARE:
Amalgam
Glass ionomer cement
Zinc oxide eugenol
Zinc polycarboxylate
Composite resin
Smart material

PREVENTIVE MATERIALS
1. Fluoride gels, foam and varnish:
• Used for remineralisation of decalcified enamel and
incipient caries.
2. Sealants:
• Indicated for preventing and arresting incipient
lesions.
• Available as clear or white, filled or unfilled,
containing Fluoride or not.

DENTAL AMALGAM
Of the many restorative materials available to the profession today,
dental amalgam is by far the most frequently used.
It has many positive properties that sustain its popularity, including
its ease of manipulation, durability, lower cost, reduced
microleakage with time and reduced technique sensitivity
compared to other restorative materials

STURDEVANT
Acc. to particle shape
A) Spherical B) Irregular C) Combined
Acc. to particle size
A) Micro cut B) Fine cut C) Coarse cut
Acc. to copper content
A) Low copper alloy B) High copper
alloy Acc. to zinc content
A) Zinc alloys B) Non-zinc alloys
MARZOUK
Acc. to the no. of alloyed metals
A) Binary alloys (eg: silver-tin)
B) Ternary alloys (eg: silver-tin-copper)
C) Quaternary alloys (eg: silver-tin-
copper-indium)
Acc. to whether the powder consists of
unmixed or admixed alloys
A) Made of one alloy
B) One or more alloys
CLASSIFICATION

Indications
 Class I, II & VI cavities
 Cuspal restoration
 Class V restorations
 As a foundation while planning for a cast
restoration in case of badly broken teeth.
 Post – endodontic access filling and core
 Teeth with questionable prognosis
 Economic status: Amalgam is the restoration of
choice for posterior teeth when patient cannot afford
expensive alternatives like cast restorations.

Contraindications
 Esthetics: When esthetics is a prime concern for the patient.
 Extensive loss of tooth structure: Amalgam is avoided as it
does not reinforce the remaining tooth structure. In such cases,
cast restorations are preferred.
 Small Class I and Class II cavities: Composite restorations
5are preferred as they are more conservative.

RecentAdvancements
Mercury –free direct filling amalgam alloys:
Mercury – free direct filling amalgam alloys consist of silver –
coated silver – tin (Ag - Sn) alloy particles that can be cold welded
to form a compaction to form a restoration. A fluoroboric acid
solution is used to keep the surface of the alloy particles clean.
These alloys can be condensed into the prepared cavity similar to the
compaction of direct guide.
Gallium based alloys: Recently gallium alloys have been developed as
alternatives to mercury in amalgam. By addition of small amounts of
indium and/or tin to gallium, an alloy which is liquid at room
temperature is produced. This alloy can be triturated with high
copper amalgam alloy to produce similar handling characteristics as
conventional amalgam.

Indium in mercury:Recently, interest has increased in admixed
amalgam containing 10% to 15% indium in the mercury.
Miracle Mix: Silver alloy admixed: Spherical amalgam alloy
powder is mixed with type II GIC powder

Glass ionomer cement, are restorative materials
which are made up of calcium, strontium
aluminosilicate glass powder (base) combined
with a water-soluble polymer (acid).
When the components are mixed together, they
undergo a setting reaction involving neutralization
of the acid groups by the powdered solid glass
base.
GLASS IONOMER CEMENT

Properties
1.Adhesion: By bonding a restorative material to tooth structure, the
cavity is theoretically sealed, protecting the pulp, eliminating
secondary caries and preventing leakage at the margins.
2.Fluoride release: Fluoride is released from the glass powder at the
time of mixing and lies free within the matrix. It can, therefore, be
released without affecting the physical properties of the cement.
3.Radiopacity: Conventional glass ionomer cements are radiolucent
but resin-modified and lining glass ionomer cement are radiopaque
due to the presence of lanthanum, barium or strontium in the
powder.
4.Thermal Expansion and Diffusibilty: Glass ionomer cement have
a linear coefficient of thermal expansion similar to that of tooth
structure.

Indications
• As pit and fissure sealants
• Class I restorations
• Tunnel restorations
• Class III & V restorations
• Root caries
• As a liner/base restoration of
deciduous teeth
• As a core build up material
• Luting cement
• As an interim restoration
Contraindications
•  In stress bearing areas
•  Labial buildups
•  Cuspal coverage
•  In mouth-breathers

Advantages
•  Adhesion to enamel and
dentin
•  Anticariogenic effect
•  Acceptable esthetics
•  Low solubility
•  Biocompatibilty
•  Less technique sensitivity
Disadvantages
•  Low fracture resistance
•  Low wear resistance
•  Colour Sensitivity to
moisture soon after setting

• Metal-reinforced GIC
• High-viscosity GIC
• Resin-modified GIC (hybrid ionomer)
• Calcium aluminate GIC
• Compomer
MODIFICATIONS OF GIC:

Recent Advancements
1.Anhydrous: In this modification the liquid is delivered in a freeze
dried form that is then incorporated into the powder. The liquid to
be used is clean water only, and this may enhance shelf-life and
facilitate mixing.
2.Resin – Modified: These are materials which have a small
quantity of a resin into the liquid formula. Less than 1% of
photoinitiators are allowed for the setting reaction to be initiated
by light of the correct wavelength.
3.Nano-Ionomer: The Nano-Ionomer delivers greater wear
resistance, esthetics and polish compared to other glass ionomers,
while offering fluoride release similar to conventional and resin-
modified glass ionomer

4.Compomer:This is the term developed by the manufacturer with a
term to incorporate some of the properties of glass ionomer with a
composite resins. A compomer is a composite resin that uses an
ionomer glass which is the major constituent of a glass ionomer as
the filler.
5. Ceramic reinforced glass ionomer: Ceramic reinforced
posterior GIC features stronger compressive, flexural and tensile
strengths as compared to amalgam.

•Used for luting and intermediate restorations
because of its medicament quality and neutral pH
hence best biocompatible cement
•Cements of low strength
•To improve the strength many modification have
been
introduced
– EBA—alumina modified
– Polymer—reinforced zinc oxide-eugenol cements.
ZINC OXIDE EUGENOL

Various types of carboxylic acids
have been used to replace eugenol
and produce a ZOE-like material.
– Zincoxide-non-eugenol cements
– EBA-Alumina modified
cements
– ZOE plus polymer Liquid: eugenol

ZINC POLYCARBOXYLATE
First dental cement to exhibit chemical
bonding to teeth.
Not used for restorative purposes because the
cement is opaque
• USE : mainly for LEUTING
– Permanent cement for crowns, bridges,
inlays, and onlays
– Orthodontic cementation
– High-strength base

COMPOSITE RESIN
To improve the physical characteristics of unfilled acrylic
resins, Bowen of the National Bureau of Standards
developed a polymeric dental restorative material
reinforced with silica particles. The introduction of this
filled resin material in 1962 became the basis for the
restorations that are generically termed composites.
Composites are presently the most popular tooth-colored
materials, having completely replaced silicate cement and
acrylic resin.

Resin matrix (Bis-GMA) with inorganic filler
particles.
1. Filler content-
Filled vs Unfilled
Flowable vs packable
Anterior vs posterior composite
2. Particle size-
3. Macro, microfilled and hybrids

• STEPS:
• Etch, wash, dry
• Enamel and Dentin
adhesives
• Composite selection
and placement
• Curing tools and
techniques

Indications16
• Small pit and fissure caries and occlusal surface caries extending
into the dentin
• Class II restorations in primary teeth not extending beyond
proximal line angles
• Class II restorations in permanent teeth that extend approximately
one-third to one-half the buccolingual intercuspal width of the tooth
• Class III, IV and V restorations in primary and permanent teeth
• Strip crowns in primary and permanent dentition
Contraindications
1.  Where a tooth cannot be isolated due to inadequate moisture
control
2.  Individuals needing large multiple surface restorations in the
posterior dentition
3.  High-risk patients that have multiple caries and/or tooth16

Advantages
•  Esthetics
•  Conserve tooth structure
•  Adhesion
•  Low thermal conductivity
•  Universal application
•  Ease of manipulation
•  Repairable
•  Can be polished at the
same appointment Advantages
Polymerization shrinkage
 Techniquesenstivity
 Time – consuming and expensive
 Difficult to finish and polish
 Increased coefficient of thermal
expansion

Recent Advancements
Flowable Composite: Flowable composites were developed mainly in
response to fulfill special handling properties for composite resins
rather than any clinical performance criteria.
Since the filler content is reduced in these composites there is a
lack of sufficient strength to withstand high stresses and because of
the increased resin content these composites exhibit more
polymerization shrinkage and have lower elastic moduli and high
fracture toughness

Art glass: Art glass is a non conventional dental polymer. It is most
commonly used in inlays, onlays and crowns. The resin matrix
consists of BISGMA/UDMA which provides a higher level of cross
linking and better control over the positions along the carbon chain
where cross linking occurs.
Artglass is considerably more wear resistant than conventional light
cured composites, good marginal adaptation, esthetics and superior
proximal contact.
Belleglass HP: Belleglass HP was introduced by Belle de
St. Claire in 1996 as an indirect restorative material. Its
resin matrix consists oBISGMA and fillers.

Nanocomposites: Nanoparticle filled composites exhibit
outstanding esthetics. They are easy to polish and possess an
enhanced wear. Nanoparticle fillers include colloidal silica or
Ormocers. These may show an enhanced fracture toughness and
adhesion to tooth tissue.
Antimicrobial Materials: Antimicrobial properties of
composites may be accomplished by introducing agents such as
silver or one or more antibiotics into the material.

As the quest for an ideal restorative material‖ continues, a newer
generation of materials was introduced.
These are termed as “smart‘‘ as these materials support the
remaining tooth structure to the extent that more conservative
cavity preparation can be carried out.
SMART MATERIALS
Smart materials have an inherent capability to sense
and react according to the changes in the
environment. They can respond to the stimuli and
environmental changes by activating their functions
accordingly and hence they are called as ̳responsive
materials

SMART MATERIALS IN DENTISTRY
ShapeMemory Alloys
Smart Composites
Self-Healing Composites
Smart Ceramics
Smart Glass Ionomer
Amorphous calcium phosphate (ACP) etc

IN SUMMARY….
“ Primary teeth are a temporary dentition with known
life expectancies of each tooth. By matching the ‘right’
restoration with the expected lifespan of the tooth, we
can succeed in providing a ‘permanent’ restoration that
will never have to be replaced.”

REFERENCES
• Pediatric Dentistry :- Nikhil Marwah
• Textbook of Pedodontics:- Shobha Tandon

Restorative materials in pediatric dentistry class

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